Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

XR INJ IL COND/URETEROPYLOGRAM

Facility

$414.00

Service Code	HCPCS 50690
Hospital Charge Code	2004349
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

XR INJ PROCEDURE GALACTOGRAM

Facility

$1,094.45

Service Code	HCPCS 19030
Hospital Charge Code	2004449
Hospital Revenue Code	361
Min. Negotiated Rate	$164.17
Max. Negotiated Rate	$164.17
Rate for Payer: Qualcare PPO/HMO/WC	$164.17

XR INJ PROCEDURE GALACTOGRAM

Facility

$1,094.45

Service Code	HCPCS 19030
Hospital Charge Code	2004449
Hospital Revenue Code	361
Min. Negotiated Rate	$31.08
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$415.89
Rate for Payer: Aetna Medicare Advantage	$328.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.08
Rate for Payer: Cigna Commercial	$547.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.56
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.17
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$34.58
Rate for Payer: Wellpoint Medicaid Managed Care	$31.08

XR INJ PROC SHOULDER ARTHRO

Facility

$1,766.00

Service Code	HCPCS 23350
Hospital Charge Code	2004174
Hospital Revenue Code	361
Min. Negotiated Rate	$264.90
Max. Negotiated Rate	$264.90
Rate for Payer: Qualcare PPO/HMO/WC	$264.90

XR INJ PROC SHOULDER ARTHRO

Facility

$1,766.00

Service Code	HCPCS 23350
Hospital Charge Code	2004174
Hospital Revenue Code	361
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$671.08
Rate for Payer: Aetna Medicare Advantage	$529.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.33
Rate for Payer: Cigna Commercial	$883.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.16
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.90
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$55.81
Rate for Payer: Wellpoint Medicaid Managed Care	$50.15

XR INJ PROC SIALOGRAPHY

Facility

$1,453.00

Service Code	HCPCS 42550
Hospital Charge Code	2004646
Hospital Revenue Code	361
Min. Negotiated Rate	$217.95
Max. Negotiated Rate	$217.95
Rate for Payer: Qualcare PPO/HMO/WC	$217.95

XR INJ PROC SIALOGRAPHY

Facility

$1,453.00

Service Code	HCPCS 42550
Hospital Charge Code	2004646
Hospital Revenue Code	361
Min. Negotiated Rate	$41.27
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$552.14
Rate for Payer: Aetna Medicare Advantage	$435.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$370.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$370.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$370.51
Rate for Payer: Cigna Commercial	$726.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.78
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.95
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$45.91
Rate for Payer: Wellpoint Medicaid Managed Care	$41.27

XR INJ SPINE CERV C1-C2 MYELO

Facility

$3,103.00

Service Code	HCPCS 61055
Hospital Charge Code	2004612
Hospital Revenue Code	361
Min. Negotiated Rate	$88.13
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$806.78
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$465.45
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$98.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$88.13

XR INJ SPINE CERV C1-C2 MYELO

Facility

$3,103.00

Service Code	HCPCS 61055
Hospital Charge Code	2004612
Hospital Revenue Code	361
Min. Negotiated Rate	$465.45
Max. Negotiated Rate	$465.45
Rate for Payer: Qualcare PPO/HMO/WC	$465.45

XR INJ SPINE LUMBAR MYELO

Facility

$498.00

Service Code	HCPCS 62284
Hospital Charge Code	2004398
Hospital Revenue Code	361
Min. Negotiated Rate	$74.70
Max. Negotiated Rate	$74.70
Rate for Payer: Qualcare PPO/HMO/WC	$74.70

XR INJ SPINE LUMBAR MYELO

Facility

$498.00

Service Code	HCPCS 62284
Hospital Charge Code	2004398
Hospital Revenue Code	361
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$189.24
Rate for Payer: Aetna Medicare Advantage	$149.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.99
Rate for Payer: Cigna Commercial	$249.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.48
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.70
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$15.74

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,096.10

Service Code	HCPCS 36598
Hospital Charge Code	321036598
Hospital Revenue Code	361
Min. Negotiated Rate	$31.13
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.99
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.41
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$34.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$31.13

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,113.85

Service Code	HCPCS 36598
Hospital Charge Code	411036598
Hospital Revenue Code	361
Min. Negotiated Rate	$31.63
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$289.60
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.08
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$35.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$31.63

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$960.00

Service Code	HCPCS 36598
Hospital Charge Code	7411478
Hospital Revenue Code	361
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$144.00
Rate for Payer: Qualcare PPO/HMO/WC	$144.00

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$960.00

Service Code	HCPCS 36598
Hospital Charge Code	7411478
Hospital Revenue Code	361
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.60
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$144.00
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$30.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.26

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,096.10

Service Code	HCPCS 36598
Hospital Charge Code	5600140
Hospital Revenue Code	361
Min. Negotiated Rate	$31.13
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.99
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.41
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$34.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$31.13

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,096.10

Service Code	HCPCS 36598
Hospital Charge Code	5600140
Hospital Revenue Code	361
Min. Negotiated Rate	$164.41
Max. Negotiated Rate	$164.41
Rate for Payer: Qualcare PPO/HMO/WC	$164.41

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,113.85

Service Code	HCPCS 36598
Hospital Charge Code	366836598
Hospital Revenue Code	361
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$167.08

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,113.85

Service Code	HCPCS 36598
Hospital Charge Code	411036598
Hospital Revenue Code	361
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$167.08

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,113.85

Service Code	HCPCS 36598
Hospital Charge Code	366836598
Hospital Revenue Code	361
Min. Negotiated Rate	$31.63
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$289.60
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.08
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$35.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$31.63

XR INJ W/FLUOR EVAL CV DEVICE

Facility

$1,096.10

Service Code	HCPCS 36598
Hospital Charge Code	321036598
Hospital Revenue Code	361
Min. Negotiated Rate	$164.41
Max. Negotiated Rate	$164.41
Rate for Payer: Qualcare PPO/HMO/WC	$164.41

XR INSERT NONTUNNEL CV CATH

Facility

$4,649.00

Service Code	HCPCS 36555
Hospital Charge Code	7411447
Hospital Revenue Code	361
Min. Negotiated Rate	$697.35
Max. Negotiated Rate	$697.35
Rate for Payer: Qualcare PPO/HMO/WC	$697.35

XR INSERT NONTUNNEL CV CATH

Facility

$4,649.00

Service Code	HCPCS 36555
Hospital Charge Code	5600124
Hospital Revenue Code	361
Min. Negotiated Rate	$132.03
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.74
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$697.35
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$146.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$132.03

XR INSERT NONTUNNEL CV CATH

Facility

$4,649.00

Service Code	HCPCS 36555
Hospital Charge Code	7411447
Hospital Revenue Code	361
Min. Negotiated Rate	$132.03
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.74
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$697.35
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$146.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellpoint Medicaid Managed Care	$132.03

XR INSERT NONTUNNEL CV CATH

Facility

$4,649.00

Service Code	HCPCS 36555
Hospital Charge Code	5600124
Hospital Revenue Code	361
Min. Negotiated Rate	$697.35
Max. Negotiated Rate	$697.35
Rate for Payer: Qualcare PPO/HMO/WC	$697.35

Know your out-of-pocket cost for care.

All Charges